Painkiller Abuse Is Spiraling, U.s. Says

Abuse of prescription pain relievers nearly tripled in recent years, sparked in part by a new painkiller making inroads in Illinois, federal officials said Tuesday.

In just the last month, officials in Lake County have linked two overdose deaths to OxyContin, a prescription drug that has become widely abused in several Eastern states since its introduction in 1996. In late March a federal grand jury indicted a Downstate physician on charges of illegally obtaining OxyContin, in Illinois' first known case involving physician abuse of the drug, state regulators said.

An estimated 4 million Americans abuse prescription drugs, according to researchers gathered by the National Institute on Drug Abuse in Washington on Tuesday to launch a public health initiative against misuse of prescription drugs, including OxyContin. Surveys indicate the abuse is worst among whites who live in suburban or rural areas, with recent increases among adolescents and the elderly.

Some patients and doctors who advocate aggressive pain treatment fear that the minority of people who abuse prescription drugs might make some doctors reluctant to give out painkilling medication at all, even to patients who truly need it.

One goal of the new federal effort is to educate medical professionals, many of whom do not even know how to recognize when a patient is addicted, said institute Director Alan I. Leshner. Abuse of OxyContin is new enough in states such as Illinois that preventive action now may keep it from taking root, he said.

"Because this is an emerging problem as opposed to a full-bore catastrophe, you are in a position to get ahead of its spread," Leshner said in an interview Tuesday.

Most experts said OxyContin, a drug whose sales exceed Viagra's, can be of great help to patients with chronic pain if used properly. But it has cut an unexpected path of addiction in some regions, where it is known by the street name "Oxy." Police in Kentucky recently arrested more than 200 alleged Oxy dealers--the state's largest-ever drug bust.

Dr. Laura Parise, an addiction specialist at Highland Park Hospital, said she has seen more abuse of OxyContin in the last year, including by a 17-year-old who said her high school friends crush the pill and snort it.

One of Parise's patients, a manufacturer's representative named Jim, said he started abusing OxyContin after getting a prescription for chronic pain from an old car accident injury.

"I took it because I wanted to be able to do more," Jim said. "After a while I didn't want to get out of my chair."

Prone to abuse

The main ingredient in OxyContin is oxycodone, a morphinelike drug long used in other pain relievers. Experts said OxyContin can be especially prone to abuse because it contains a large dose, which normally is released from the pill over many hours. But crushing or chewing the pill can release the medication all at once.

Some abusers of prescription drugs begin as normal patients who lapse into addiction because of poor monitoring by a doctor or an underlying psychiatric condition that makes them susceptible, experts said.

Others are addicts who seek out painkillers like OxyContin or Vicodin for the heroinlike high they can get from snorting or injecting crushed pills. Such users often get the drugs through unscrupulous doctors or by forging prescriptions.

Forgery of OxyContin prescriptions became so widespread in Maine and Virginia that the drug's manufacturer, Purdue Pharma, announced plans last month to distribute tamper-proof prescription pads to doctors in those states.

One advertising executive from the North Shore said he supplied his Vicodin habit by "doctor-shopping"--alternating among three or four doctors who never gave him enough pills at one time to raise suspicion. His prescriptions called for him to take seven pills each week. By the end of his 3 1/2-year bout with the drug, he was taking 12 to 14 pills a day.

"I was as addicted as any street user," said the executive, who asked not to be identified. "The preoccupation of getting pills was an obsession you can't believe. Even if I had 300, I was still worried I would run out."

The executive said he occasionally got Vicodin pills through a dentist who would supply them for $4 each--many times the drug's retail value.

More taking painkillers

The 1990s saw a huge spike in the use of prescription drugs for non-medical reasons, according to household surveys by the federal Substance Abuse and Mental Health Services Administration. People who used painkillers for the first time jumped from 564,000 in 1990 to more than 1.5 million in 1998, the agency estimates.

During the same period the estimate for young people between the ages of 12 and 17 jumped more than fivefold, to 718,000 in the most recent survey. The figures indicate an especially sharp rise among adolescent girls, said Howard Chilcoat, a professor in the department of mental hygiene at Johns Hopkins University.